Key result
Treating systolic hypertension above 160 mmHg in older people with thiazides, calcium-channel blockers, or angiotensin II receptor blockers reduces cardiovascular events and mortality.
Why the study?
Does antihypertensive therapy reduce cardiovascular risk in older people with hypertension?
Does antihypertensive therapy reduce cardiovascular risk in older people with hypertension?
Treating hypertension in older adults with lifestyle changes and first-line medications (thiazides, CCBs, ARBs) reduces cardiovascular risk, though generalizability to frail patients is uncertain.
Supports prioritizing BP reduction over agent class in older hypertensives; leaves open optimal strategies for frail patients.
Systolic hypertension above > 160 mmHg is associated with cardiac, renal and cerebrovascular complications. In older people, treating hypertension offers cardiovascular benefits. Reduced salt intake and weight loss for obese older people improves blood pressure without any risk of adverse drug reactions. Blood pressure reduction is more important than the type of antihypertensive for cardiovascular risk reduction. The recommended drugs to start an older patient with isolated systolic hypertension are thiazides, calcium-channel blockers or angiotensin II receptor blocker. Studies were performed on relatively fit older patients, so benefits may not be generalisable to frail elderly. Alpha-blockers and beta-blockers are not recommended for first line therapy of hypertension but may be considered if there are other indications for their use.
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Win et al. (2017) conducted a review in Hypertension. Antihypertensive therapy vs. Placebo or standard care was evaluated. Treating systolic hypertension above 160 mmHg in older people with thiazides, calcium-channel blockers, or angiotensin II receptor blockers reduces cardiovascular events and mortality.
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